Older patients, pharmacists, and physicians generated similar lists of information that patients should receive when prescribed a new medication, yet there was substantial disagreement between groups about what information is critical to convey. Even some guideline-specified topics21–25
were not universally specified. Furthermore, physician, pharmacist, and patient groups had varied beliefs about who should provide critical medication-related information. Time constraints for patient counseling increase the importance of clinicians understanding their expected role.
Many participants felt that pharmacist education about certain important topics was acceptable, suggesting that physicians and pharmacists might collaborate to provide patients with comprehensive communication about new medication prescriptions. Pharmacist–physician collaborations to manage chronic patient medications in one study led to more-appropriate prescribing and lower patient medication costs.37
These models could be adapted to new medication counseling by allocating responsibility for transmitting new medication information to improve prescription practices. Physician and pharmacist professional groups could work together to delineate roles in medication prescribing in a manner that allows for comprehensive counseling in a time-efficient manner. In the current system, important information may be inefficiently transmitted because of overlapping discussion, although some patients and pharmacists valued repetition. Information may be missed because of diffusion of responsibility. Physicians often do not communicate essential information27
and may believe that pharmacists will fill in the gaps.15
Although the Omnibus Budget Reconciliation Act of 1990 mandates that pharmacists counsel patients receiving new prescriptions, pharmacists are exempt from this responsibility if a patient refuses to receive the information.41
As a result, pharmacists do not speak with nearly 40% of persons receiving new medications.34
In general, physicians were reluctant to rely on pharmacists to convey essential medication-related information. This may be because physicians consider themselves to be the primary source of patient information,15
although it may also be that physicians are unfamiliar with working with pharmacists as part of a healthcare team and are hesitant to entrust an unknown pharmacist with the task of imparting important medication-related information. Many physicians do not know what to expect from pharmacists.42
Better delineation of new medication information transmission responsibilities by both parties could enhance and streamline this important process.
Nearly all focus groups concluded that physicians or pharmacists could adequately discuss potential medication side effects of a new prescription, although the postulated content of these conversations varied. Physicians in this study queried whether these conversations would scare patients, but studies have shown that side-effect discussions do not adversely affect patient medication adherence16–19
and do not increase the number of side effects experienced.20
The majority of patients want as much side-effect information as possible from their physicians,11,43
but this study suggests that patients may be amenable to obtaining this information from other sources, such as from pharmacists or written materials. Time-pressured physicians might assess patients’ level of interest and then relay contextually grounded information of the desired depth, giving patients a plan should they encounter adverse reactions.
This study has several limitations. A focus group format was chosen for the study to facilitate sharing of thoughts and ideas, but this method is susceptible to incomplete ascertainment. For example, physicians did not state that it was critical for them to describe a medication’s purpose but routinely convey this information in practice. All of the patients in the study spoke English, most had at least some college education, and all were active enough to participate in senior center activities. Because the moderators were physicians, some focus group participants may have curtailed their comments. Physician focus groups were of shorter duration than the other groups, which may have constrained the amount of time physicians spent talking about some topics, yet physicians raised more critical aspects of new medication information than any other group.
In conclusion, this study demonstrates incongruent beliefs about medication-related counseling among older patients, pharmacists, and physicians, which may lead to inadequate communication when a new medication is prescribed. Delineation of responsibilities concerning counseling patients about new medications and models to transmit information in an efficient fashion is needed.